Developing a policy for do not resuscitate orders within a framework of goals of care.

Title

Developing a policy for do not resuscitate orders within a framework of goals of care.

Creator

Kaldjian LC; Broderick A

Publisher

Joint Commission Journal On Quality And Patient Safety / Joint Commission Resources

Date

2011

Subject

Humans; Policy; decision making; DNAR; Palliative Care/og [Organization & Administration]; Hospital Administration/es [Ethics]; Patient Care Planning/es [Ethics]; Patient Care Planning/og [Organization & Administration]; Resuscitation Orders/es [Ethics]; Palliative Care/es [Ethics]; Terminal Care/es [Ethics]; Terminal Care/og [Organization & Administration]

Description

BACKGROUND: Discussions about DNR (do not resuscitate) orders or code status are common but can be difficult and may not lead to accurate understanding between clinicians and patients. These discussion are often isolated from the larger context of a patient's plan of care. Addressing patients goals of care, which provide a basic orientation for clinical and ethical decision making, may improve clinicians' understanding about patients' code-status preferences., A POLICY FOR DNR ORDERS WITHIN A FRAMEWORK OF GOALS OF CARE: On the basis of experience at the University of Iowa Hospitals and Clinics, which entailed incorporating goals of care in ethics education, identifying six goals of care through a structured literature review, surveying hospitalized adults, and integrating goals of care into palliative care education, the University of Iowa Hospitals and Clinics ethics committee revised the hospital policy regarding DNR orders. The intention was to avoid treating DNR orders as an isolated clinical phenomenon and to instead place the discussion of DNR orders in the more general context of end-of-life discussions and to place both of these discussions within an even more general framework of goals of care., CONCLUSIONS: The DNR order policy represents an effort to translate conceptual analysis, empirical research, and clinical experience into hospital policy so that clinicians are encouraged to place code-status discussions within a larger, goal-oriented context. Using goals of care to guide decision making about DNR orders and other treatments should enhance the quality of patient care by improving the fit between the biomedical information we provide patients and the values our patients rely on to make their medical decisions.

Rights

Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).

Type

Journal Article

Citation List Month

Backlog

Pages

11-9

Issue

1

Volume

37

Citation

Kaldjian LC; Broderick A, “Developing a policy for do not resuscitate orders within a framework of goals of care.,” Pediatric Palliative Care Library, accessed July 31, 2021, https://pedpalascnetlibrary.omeka.net/items/show/11575.

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